Health Secretary Andrew Lansley was on BBC1 this morning discussing his plan to transfer control of NHS purchasing to GPs. Mr Lansley said that because of Labour's increased NHS spending, Britain now spends European quantities of money without achieving European standards of treatment. It is time, he said, to sweep away Labour's bureaucracy and targets and trust the clinicians who care for us with the NHS' budget. He is planning a £1bn cull of bureaucrats and diversion of that money to the frontline.

The Civitas think tank has warned, however, that Mr Lansley's reorganisation plans could "set the NHS back three years".

Analysing the impact of the last reconfiguration of commissioning on performance, Civitas worries that it took three years for merged Primary Care Trusts to achieve levels of performance comparable with the pre-merger period.

James Gubb, Director of the health unit at Civitas, said:

"The NHS is facing the most difficult financial times in its history. Now is not the time for ripping up internal structures yet again on scant evidence base, but for focusing minds on the task ahead and really getting behind the difficult decisions PCTs, as commissioners, will have to make."

Civitas also worries that fundholding may have worked under the last Tory government when it was voluntary but may be less effective as a compulsory measure:

"GP fundholders were self-selected volunteers for the programme, tending to be well-organised practices in middle-class areas, enthusiastic about taking on commissioning budgets. There is no evidence to draw on to support GPs across the country taking on commissioning as consortia, as is proposed by the government."

Gubb points to the Mid Staffordshire hospital crisis where 1,200 people
died unnecessarily. He quotes the Frances Inquiry's warning about the
dangers of reorganisation, causing a "lack of capacity and
organisational memory".